The links below will provide you with the most current system issues that the department is experiencing as well as information regarding resolutions.

HFS System Issue

HFS System Issue

Problem Begin Date

Problem Fix Date

Provider notice dated 10/24/17 informed Community Mental Health providers of an increase in reimbursement rates effective for dates of service on and after 8/1/17.

Programming to pay claims at the higher reimbursement rate was implemented on 9/23/17.Claims paid prior to 9/23/17 were not paid the increased rate.

August 1, 2017​

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On 12/4/17, the Department adjusted paid claims with dates of service on or after August 1, 2017 up to the provider charge or the new maximum allowable rate, whichever was less.

If reimbursement was less than the new maximum allowable rate, providers must void and rebill the claim with a new provider charge reflecting the enhanced reimbursement rate

Hospital outpatient fee-for-service physical therapy and occupational therapy services are either paying inappropriately or rejecting in error when billed by hospitals under the same provider number.

​July 2012

​June 13, 2017

A timely filing override for impacted claims will be allowed for 180 days from the provider notification date of 10/02/17.Instructions for the paper override process are explained in detail on the Department’s Non-Institutional Providers Resources webpage.

​Claims submitted to the Department via MEDI/DDE using Place of Service code 02 for the Telehealth distant site service are not processing. Claims are being accepted when submitted, but are not showing claim status.

​Claims with dates of service on or after January 1, 2017

​May 19, 2017

MEDI/DDE has been modified to allow for entry of the Place of Service code 02 at the claim and service line levels.Providers have always had the option to submit claims on paper or via batch 837P upload as an alternative. If a provider did not have this option, a timely filing override for impacted claims will be allowed 180 days from the fix date of 5/19/17.Instructions for the paper override process are explained in detail on the Department’s Non-Institutional Providers Resources webpage.

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Claims submitted to the Department by enrolled Licensed Clinical Psychologists (LCPs) and Licensed Clinical Social Workers (LCSWs), for dates of service on/after January 1, 2017, are rejecting P83/Provider Type Not Valid For Claim.

Effective January 1, 2017, the Department’s policy changed to allow fee-for-service (FFS) reimbursement for certain services provided by individual LCPs and LCSWs.Programming to accept claims submitted by these provider types is not yet implemented.As a result, all claims submitted by LCPs and LCSWs are rejecting P83/provider Type Not Valid For Claim.

​January 1, 2017

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May 18, 2017

Claims with dates of service between 1/1/17 and 5/17/17 that have previously rejected P83/Provider Type Not Valid For Claim must be resubmitted to the Department.Timely filing override for impacted claims will be allowed 180 days from fix date of 5/18/17.Instructions for the paper override process are explained in detail on the Department’s Non-Institutional Providers Resources webpage.

​Claims rejecting incorrectly with error code A82, for a participant who is an IDOC/IDJJ Inmate, when a provider (Non-Institutional providers billing both electronically and paper claims) is billing for services that were rendered in the hospital, inpatient, outpatient or emergency room setting

​June 2016

​ April 6, 2017

Resolution for Impacted Claims:

Claims must be rebilled.For claims past the 180 day timely filing deadline, providers must re-bill the Department on paper and request a time override using the HFS 1624, Override Request Form.Instructions for the paper override process are explained in detail on the Department’s Non-Institutional Providers Resources webpage.Providers will have 180 days from the fix date to qualify for an override.

​Participant eligibility was not properly coded for some participants in the Department’s systems. Participants were coded as Title 21 when they should have been coded as Title 19. On December 21, 2016, the eligibility was corrected to Title 19. Depending on when claims were received for processing, this change may have affected private stock vaccine procedure code reimbursements.

If private stock vaccines were administered when the participants were in Title 21 status and claims were processed after the eligibility status had been changed to Title 19, the Department reimbursed the Unit Price rate on the Practitioners Fee Schedule based on the participant’s eligibility on the date the claim was received.

If private stock vaccines were administered and billed while the participants were still in Title 21 status, the Department reimbursed the appropriate rate.

​10/1/2016

12/21/2016

The Department will initiate adjustments.

When adjusted, claims will be identified on the Form HFS 194-M-1, Remittance Advice with the following message: Adjustment Reason Code 3450 Vaccine Adj/Eligibility Update.

Providers should not process adjustments.

For claims processed through Managed Care plans, providers must work with the individual plans for reimbursement.

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When the new VFC policy was implemented on 10/1/2016, the system did not process certain vaccine service lines correctly. Vaccines administered to Title 19 participants were paid at the State Max rate (private stock rate) and vaccines administered to Title 21 participants were paid at the Unit Price rate (VFC $6.40 rate) on the Practitioner Fee Schedule.

The discrepancy affected service lines and not the whole claim. For example, a provider may have billed five vaccine procedure codes on one claim and all vaccine procedure codes paid correctly except one.

​10/1/2016

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11/18/2016

The Department will initiate adjustments.

When processed, adjustments will be identified on the HFS on Form HFS 194-M-1, Remittance Advice with the following message: Adjustment Reason Code 3450 Vaccine Adj/Eligibility Update.

Claims that were paid $6.40 instead of the State Max rate (private stock) will be adjusted to pay the State Max rate plus the Unit Price ($6.40) rate.

Additionally, some DHS/DMH claims submitted by Community Mental Health Centers for FY’17 dates of service are receiving the D04 - Suspended for Department Review - error code.This is an informational only error message and claims will continue to process and adjudicate once the hold edit is lifted.

​Incorrect payments or A59 rejections - July 2016

D04/Suspended for Department Review – July 1, 2016 for FY’17 claims with dates of service on or after 7/1/16

A59 rejection or incorrect payment – September 1, 2016.

D04 – contractual funding information was loaded on September 29, 2016.All held claims were released into processing for re-editing and final adjudication on September 30, 2016.